In contrast with the countless stresses of our times, it is immediately evident that
the spirit of man throughout Christendom is a splendid thing to behold at Christmas
time. This is as it should be, for the deep and abiding Faith of these multitudes of
people has been a constant companion in times of adversity and a pillar of strength
in the face of disaster. Sheer happiness during the Christinas season is a genuine and
spontaneous expression and its recurrence each year bespeaks its bona fide and per-
manent qualities which for almost 2000 years have been perpetuated among mankind.
To all members of our Medical Department whether serving at sea. ashore, or
in a distant foreign land, I extend my best wishes for a Merry Christmas and a
Happy New Year.
To your loved ones, we owe a special debt of gratitude. Their faith in the future,
their determination and adaptation to the process of periodic moves to new geographic
areas, leaving behind their newly developed and closest friends — only to find new friends
at their next station — all of these things are part and parcel of the Navy's strength.
To these thousands of family members I also extend my deep appreciation for your
devotion and moral support to your Navy man. May you also experience a holy and
happy Holiday Season.
EDWARD C. KENNEY
Rear Admiral, MC, USN
United States Navy
MEDICAL NEWS LETTER
Friday, 25 December 1964
Rear Admiral Edward C. Kenney MC USN
Rear Admiral R. B. Brown MC USN
Deputy Surgeon General
Captain M. W. Arnold MC USN (Ret), Editor
William A. Kline, Managing Editor
Aviation Medicine Captain C. E. Wilbur MC USN
Dental Section Captain C. A. Ostrom DC USN
Occupational Medicine CDR N. E. Rosenwinkel MC USN
Preventive Medicine Captain J. W. Millar MC USN
Radiation Medicine CDR J. H. Schulte MC USN
Reserve Section Captain C. Cummings MC USNR
Submarine Medicine CDR J. H. Schulte MC USN
The U.S. Navy Medical News Letter is basically an
official Medical Department publication inviting the
attention of officers of the Medical Department of the
Regular Navy and Naval Reserve to timely up-to-date
items of official and professional interest relative to
medicine, dentistry, and allied sciences. The amount
of information used is only that necessary to inform
adequately officers of the Medical Department of the
existence and source of such information. The items
used are neither intended to be, nor are they, sus-
ceptible to use by any officer as a substitute for any
item or article in its original form. All readers of the
News Letter are urged to obtain the original of those
items of particular interest to the individual.
Change of Address
Please forward changes of address for the News Letter
to: Commanding Officer, U.S. Naval Medical School,
National Naval Medical Center, Bethesda, Maryland
20014, giving full name, rank, corps, and old and new
FRONT COVER: Original sketch designed for the Medical News Letter by Mrs. Josephine L. Bottazzi and Mrs.
Sara B. Hannan of the Graphic Section, Administrative Publications and Printing Branch. Administration Divi-
sion, Bureau of Medicine and Surgery. As staff artists and medical illustrators in BUMED, their dedicated serv-
ices are available to and utilized by all divisions, branches and sections in this Bureau, at one time or another.
Versatility, talent and keen insight into the areas of Medical Department activity which their work supports
characterize these fine Civil Service career employees. To both, a hearty WELL DONE! — and a Merry Christmas
and Happy New Year salute from the Medical News Letter staff. — Editor
NOTICE: See back cover for contents of this issue. — Editor
The issuance of this publication approved by the Secretary of the Navy on 4 May 1964.
U.S. NAVY MEDICAL NEWS LETTER
LT J. C C&ttmgham MC USN*. From the Proceedings of the Monthly Staff Con-
ffanemrxif. V. S. Naval Hospital, NNMC, Bethesda, Md. 1963-1964.
The pBiiiEiiraify grium and perspiring patient, fearful
of mB&wfflg <m toEnsMnng- has become a constant fixture
in the pffMffiHimsJiEajll wsmSs. His suffering was anticipated
by Ms pflngsaciiaims audi its accepted in the knowledge that
iitt wiil (iisaippKaor inn damme. This is the expected, the usual,
aunrfl tie imswtetMs: [postoperative pain — probably the
most iraqprantt amd! nmstt neglected painful state in the
hasptoll stoamtnum. A mecemitt survey of narcotic practices
ibm Jdffararam Dtoik HsMjntall in Houston disclosed that
ttww-timinfe <a£ ad dimes of narcotics dispensed for in-
patients ware uusdS am the surgical services and, of
these, (flunBe-ftwartiis were used in the treatment of post-
The PfliiitouDpftiy off Paiim
I^im — tits existentee and ills fears — has had a profound
died ram mnaim's task philosophy since earliest of civ-
iiiratikm. He the tfflnhM chapter of the book of Genesis it
k Drafted! tttat Ceni saiidl to Eve after the eating of the
fuMbikdUlam innit W I will gaesifly multiply thy sorrow and
thy oanuceplliioinc ibm smsarm thou shah bring forth chil-
dbnam-'" Mntt 00% was the judgment of God for the
aTfnm nmniitiitiiiTOP <of the aniigjanial sin cast in the framework of
BsadHy paiin, (bust,, md too have been the actions of rulers
of states aumdl onJhiHrs iim authority toward those convicted
(Oif arihnme.. Unwtoiulb*afly much thought has gone into
dewnsingg mneaunis off pnmJondimg pain in the interest of
Op lumffli tike fflnrodkffle of (the 19th century, Aristotle's
pHtofBfflfftiir ffranffiepfl; of -pain being the opposite of
pteasiunie wn& nBnif eapsreaukmt of unpleasantness" was ac-
cepted! ttatrauaj^tomutt the world. Then came the "law of
speriffie nnarwe emiHigiies"* set forth by Muller in 1840,
whfch <rajim fee inmftnrpnatral to mean that each sensory
eajauailliiitf has; ntts owmi specific sensory unit. The deveiop-
smieimt off this cranmceptt has continued into the present day
mill wpum it iis haisBftl inmost of what we have been taught
ahouut sransatMons.. Themeffore, from Aristotle to the
pmesemilL, iit Boas tafceiD mraaim 2,500 years to discard the
mystica*™ assffloaftisdl with pain and finally approach the
• Btaullom its tiftir AirosUiiKsioitogs Sentiic liSNH, NNMC, Bethesda,
subject scientifically. And it will probably take again
that long to unravel the multitude of components which
comprise the total pain experience of an individual.
Pain Perception Vs. Reaction
Pain has two components: the original sensation, and
the reaction to that sensation. Before we as physicians
can prescribe analgesics, we must understand not only
which of the two components or both that we are treat-
ing, but also how each varies among individuals.
Much work has been done to evaluate patient's pain
threshold in the belief that individual suffering was re-
lated directly to the amount of pain stimulus. Beecher
has shown that there is no correlation between pain
threshold and the suffering experienced by the patient.
A small dose of morphine which does not raise the pain
threshold any more than a large dose of aspirin, is much
more effective in relieving pain than the large dose of
aspirin. Since the "perception" component in man is
the principal site of action of analgesic drugs, the fol-
lowing are a few characteristics of perception of pam
that are specific:
1. There is no constant, necessary, or proportionate
relationship between perception of pain and the reaction
to that perception.
2. Intensity of pain perception arising from a lesion
is independent of the size or location of the lesion.
3. When two or more sources of pain stimuli exist
coincidentally, perception is usually monopolized by
the most intensive; it appears as if in competition for
recognition by the central processing mechanism, one
wins and is accepted and the others are more or less
ignored. This may explain a patient's failure to com-
plain of pain in one area such as the chest, when there
is pain from another area such as the pelvis. This
phenomenon is dependent upon apparent absence of
summation. It is the basis for the device learned in
childhood that the pain of sudden trauma, such as a
bruise, can be alleviated by the institution of another,
such as biting the lips.
4. Though perception is relatively constant, it is
amenable to modification: by drugs and by powerful
emotional states. Thus the recently badly-wounded may
IP. S. NAVY MEDICAL NEWS LETTER
show little or no evidence of pain, not only because re-
action is diminished or absent, but also because percep-
tion itself may be grossly disturbed. The patient, on
questioning, may deny that he feels any pain.
Pain reaction in contra-distinction to perception is
widely variable among different individuals, and in the
same individual from time to time. It has no definite
localized apparatus of function. It is a cognitive process
and thus, being affective, is under the influence of the
whole gamut of the patient's experiences, emotions and
needs, as well as the environmental circumstances at the
Although there is some objective evidence suggesting
the existence of severe pain — (tachycardia, drawn
facies, pallor, sweating) — reaction is largely immeasur-
able. The manifestation of reaction is the patient's
complaints and his physical and mental responses: they
constitute pain reaction.
Several important further characteristics of pain
should be considered:
1 . Pain varies widely in severity from time to time,
and very severe pain does not persist unchanged for
any protracted period. The pain of carcinomatoses is
particularly prone to waxing and waning,
2. Occasionally, severe and intractable pain from a
known causative lesion such as a malignant mass or
from trigeminal neuralgia may cease abruptly for no
3. The presence of general disability, malnutrition,
fatigue in any circumstance in which emotional stress
or anxiety occurs makes the reaction to a given pain
stimulus more marked or more difficult to treat.
4. Tolerance for pain is a highly individualized trait.
It is dependent upon many factors: cultural, familial,
environmental. It frequently appears to be influenced
by the patient's concept of what kind of reactions are
appropriate or expected of him in the circumstances at
In a recent survey of 293 postoperative patients who
were given alternate injections of normal saline and a
narcotic in treatment of their pain, no less than 43.2
percent of the 293 doses of saline resulted in relief.
(Each dose was given within 20 hours after major ab-
dominal procedures.) This great power strongly supports
the view that drugs are capable of altering subjective
responses and symptoms, and do so to an important
degree through their effect upon the reaction com-
ponent of suffering. Beecher has reported the results
of 15 separate studies involving over 1,000 patients in
which placebos were found to have an average sig-
nificant effectiveness of 35.2 percent. These figures are
supported by dozens of other experiments showing that
the usual reported figure of 26 percent effectiveness of
placebos may actually be a conservative statement.
The "pharmacologic action" of placebos is not limited
to pain relief. Beecher reports the following incidence
of side reactions: dry mouth, 9 percent; nausea, 10 per-
cent; sensation of heaviness, 18 percent; relaxation, 9
percent; fatigue, 18 percent; sleep, 10 percent. He also
reports patients developing rashes, angioneurotic edema,
and constricted pupils, not only with the placebo, but
also later with an injection of a narcotic.
Most postoperative patients are not consistent placebo
reactors or non-reactors, at times obtaining relief from
placebos and other times not. This introduces a tem-
poral characteristic apart from basic personality char-
acteristics, in determining placebo response. This tem-
poral characteristic may be dependent upon such things
as day or night, visiting hours, time from operation,
and implication of the patient's disease. In comparing
a group of consistent placebo reactors with a group who
consistently failed to obtain pain relief from placebo,
there have been found significant differences in the
attitudes, habits, educational backgrounds and person-
ality structure between the patients. Yet the placebo
reactor could not be identified by the casual observer,
but could only be delineated by extensive and careful
psychologic techniques. These investigations are stimu-
lating further studies on the effect of personality char-
acteristics of drug action.
Characteristics of Postoperative Pain
There are many misconceptions among physicians as
to the severity of pain which follows certain surgical
procedures, and more especially as to the relative merit
of various drugs in its relief. These "clinical impres-
sions" are prevalent because nurses, not physicians, give
the drugs for postoperative pain. Observations made by
some nurses may be based on criteria which do not
necessarily coincide with good medical practice. Much
of what is believed to be known about postoperative
pain is the result of such observations as recorded in
1 . Incidence. Periodically, investigators who use
postoperative patients for their studies re-discover that
many patients do not have pain following surgery.
Papper, Brodie, and Rovenstine found that 44 percent
of their 237 postoperative patients failed to complain
of pain. Included in this group were 108 patients who
had intra-abdominal or intra-thoracic procedures, and
of these, 27 percent did not complain of pain. laggard,
Zager, and Wilkins found that 36 percent of 1 ,005
patients received no narcotics during the entire post-
operative period. Keats reported 21 percent of 104
patients who had undergone either gastrectomy or co-
lectomy received one or no dose of narcotics during
the entire postoperative period. Papper, Brodie and
Rovenstine found that 58 percent of patients having
surgery of the superficial parts of the body did not com-
plain of pain after operation, in contrast to only 27
percent for those having abdominal or thoracic pro-
Pain is the postoperative patients chief complaint,
but he may complain bitterly and primarily of symp-
U. S. NAVY MEDICAL NEWS LETTER
toms such as sleeplessness, discomfort from gastric tube
or oxygen catheter, sore throat, headache, backache,
uncomfortable position in bed, bladder discomfort from
indwelling catheters, tightness and weightiness of casts,
or discomfort from shivering in an air-conditioned
room. These symptoms as primary complaints are re-
sponsible for JO percent to 15 percent of all requests
for medications, and narcotics are not required for
2. Duration. Pain of severity sufficient to require
narcotics usually disappears within 48 hours after
surgery, with 87.4 percent of all doses of morphine
following major intra-abdominal surgery being adminis-
tered during this time. There is little need for narcotics
after 48 hours. Exceptions to this usual time course
are present in patients who develop certain surgical
complications, as infection, and in patients who develop
psychic dependence on the drug or the injection per se,
or the associated care. Such exceptions are rare. Pain
of lesser magnitude may persist for variable periods
following operation and is readily controlled by non-
Frequency of Morphine Administration During 8-Hour Periods
Following 60 Major Intra-Abdominal Surgical Procedures
No. of patients
Realizing that narcotics, as a rule, were necessary
only during the first 48 postoperative hours, together
with the knowledge that most prn narcotic orders were
effective for the duration of hospitalization, Beecher
and Keats at Massachusetts General Hospital attempted
to estimate the magnitude of some of these abuses by
comparing the amount of morphine a specific group
of patients needs to the amount actually received.
Thirty ward patients who had uncomplicated cho-
lecystectomies by standard operative procedures under
ether anesthesia were allowed to receive 10 mgm of
morphine as often as every hour to control pain. They
were kept comfortable at all times and given drugs for
as long as necessary, postoperatively. For comparison,
the hospital records of identical groups of ward, semi-
private, and private patients were randomly collected
and the amount of postoperative morphine they re-
ceived was tabulated. The mean doses of morphine per
patient (+ standard error) following cholecystectomies
in these four groups were as follows:
Ward group studies — 3.2 + 0.4
Ward group, hospital records — 5.6 + 0.4
Semi-private group, hospital records — 9.8 + 0.7
Private group, hospital records — 13.4 + 1.2
When these data were broken down into time in-
tervals following operation, it was found that in the
private group 40 percent of the total narcotics were
administered more than 48 hours following surgery.
Although there are many psychosocial implications in
these data, the authors of these reports attributed the
prolonged administration of narcotics to nursing prac-
tices. For example, some nurses who were interviewed
said they were taught that every postoperative patient
must have two doses of morphine during the first post-
operative night. Some nurses routinely give all post-
operative patients a narcotic at 1 1:00 p. m. to guarantee
a quiet night and time for manipulating their Cardex.
3. Patient Variables. Efforts to correlate severity of
postoperative pain with certain characteristics of the
patients themselves have been largely unsuccessful.
Most researchers have been unable to correlate the de-
gree of postoperative pain to age, sex, type of anesthesia,
duration of anesthesia, previous medical history, pre-
vious surgical history, previous hospitalizations, ob-
vious personality types, noticeable personality disorder,
or presence of preoperative pain. Pain following sur-
gery seems to be random with regard to obvious patient
Treatment of Postoperative Pain
Parenteral injections are the accepted route of drug
administration to the postoperative patient. Oral anal-
gesics are not ideal because the disturbances of gastro-
intestinal function so common following operation,
result in unpredictable drug absorption. Most anal-
gesics are ineffective via the oral route; the ineffective-
ness of morphine by mouth has been noted by many
observers, although this fact is still not generally ap-
preciated. Beecher and Keats found that when 10 mg
of morphine, 60 mg of codeine, 300 mg of aspirin, and
600 mg of aspirin were given orally to postoperative
patients, the only effective analgesic was 600 mg of
aspirin. Neither morphine nor codeine could be dis-
tinguished from a placebo under these circumstances.
Parentally, no drug which has been adequately stud-
ied has been found to produce the analgesia of mor-
phine with less side reaction than morphine. Based on
current information, all available narcotics with the
U. S. NAVY MEDICAL NEWS LETTER
exception of codeine, will produce adequate postopera-
tive analgesia if given in equivalent dosage, and at this
dose the same side actions might be expected as with
morphine. (The analgesic potency of codeine does not
equal that of morphine, even 120 mg, and at this dose,
codeine is a potent respiratory depressant.)
The dose-response curve, characteristic of drug action
in general, applies to the analgesic properties of nar-
cotics. An optimal dose can be determined, exceeding
which further increase will not result in proportional
increase in analgesia. For morphine in postoperative
pain, the dose is 10 mg (1/6 grain) per 70 Kg of body
weight. The significant increase in side reaction, such
as nausea, vomiting, and respiratory depression, occurs
at higher doses in return for small additional analgesia.
Relationship Between Dose of Morphine
and Incidence of Analgesia
Greater than Placebo
Incidence of Pain Relief fof
According to Omdtar
Postoperative Doses inn 199
70 Kg of
Pain occurring earlier in the postoperative period is
more difficult to relieve than that occurring after 24
hours. Effective pain relief as compared to order of
doses, shows only 63 percent relief from the first dose
with the effectiveness progressing to 89 percent by the
fourth administration postoperatively.
The generally accepted QQ»puurii«5m, mmg nW mis, is
that morphine is 10 tonnes as potffinnt as itemDoralL al-
though 10 mg of morphihnie prafrailMy giiwes nmsHre pn»-
found analgesia than 100 nmg ran' <dkmmtHnn>IL.
Survey of records from ow tawpitlaiD ptaimiiiaey ire-
veals the following statistical irelaltaaMiHiJnnps tetwaam imor-
phine and demerol. For tlkraaige ocfflnpinriiBim. ffigiicnfs
were compiled on the analgesic oqpmvjifaiiitt «sff 11(0) mrag of
morphine = 100 mg of denwmafL,
1. In the multiple dose wialk. dkunnanofl omMs atinDmt
twice as much as morphine C$ft.ffir5 par <t$me vs. 2%#
2. In the Tubes the same raSra> its ffiminnadl ((2Dc for
demerol vs. 124 for morphine).
3. On the general surgical serwkss ftWamdls T-12,
8-C and 4-Ct VA times unrane afcramemaO is uirsedl than
4. In the recovery room. mnKHrpfiniiime is nasal twice as
frequently as demerol.
5. Considering all surgical sareisaes. nBanmnroill and! mnor-
phine usage is about equal.
A review of the concepts amdl dteaanatiejiistiics off pain
has been presented as a fljadtgrcwiuimdl inmr itflac dftsaJHSMsm
of postoperative pain relief, in smimmmiairf, mat all post-
operative patients have paia. ¥w tritasc wto «to. the
amount of suffering relieved! wiffll dkywondj mm ttfte ana&eOQD—
gent use of available drugs, gm«dl nnuiinaiimg came, mud a
consideration of the psychologic unsafe rf Oft
SNAIL INVESTIGATION CENTER FOR THE AMERICAS
Under an agreement between the Brazilian Ministry
of Health and the Pan American Sanitary Bureau,
which acts as the WHO Regional Office for the Ameri-
cas, a Schistosomiasis Snail Identification Center has
been set up at the National Institute for Rural Endemic
Diseases, Belo Horizonte, Brazil.
The incidence of schistosomiasis or bilharziasis, un-
like that of most communicable diseases, is increasing.
It already affects some five million people in the
Americas and is becoming an important health problem
in a number of countries and territories, including
Brazil, the Dominican Republic, Puerto Rico; St. Lucia.
Surinam, Venezuela, and other CaurfihiKsani catmmtiries.
In some tropical areas whole wflHagps atne affientoiL
Research workers at the Center will iimwestliipiute how
snails live, their breeding faofoilK, nine uHiwsirse* ttfaitt affect
them, the birds and animniah tftaut pro man them, etc.
Such research may eventually Head to nine eradication
of bilharziasis from the Anrarkas and a tatter life for
millions of people.— WHO CThnnraniikfle 1$((3)): 103.
CANCER IS NOT CONTAGIOUS
Don't fear cancer: do somroctthiimg atountt StL.
U. S. NAVY MEDICAL 1NIEWS LETTER
MOBILE EMERGENCY CART FOR INTENSIVE CARE WARD
U.S. NAVAL HOSPITAL, NEWPORT, RHODE ISLAND
CAPT Alexander C. Hering MC USN, LT Gordon I. Goldstein MC USNR, LCDR
Doris M. Sterner NC USN.
An intensive care ward functions well when there is
a minimum of confusion and a maximum of efficiency.
Toward this end the idea of supplies-in-motion rather
than peop!e-in-motion developed.
A standard, wheeled dressing cart (Fig. 1) became
available from on-board stocks when two examining
rooms were combined. Hospital carpenters fabricated
drawers and shelves of plywood, labelled in startling
red and black, to fit accurately in the cart, (Fig. 2). The
smaller shelf labels read:
cardiac arrest tray
adult tracheotomy tray
pediatric tracheotomy tray
LV. solutions, polyethylene catheters, antiseptic,
"Amha" resuscitator and a chart showing closed chest
U. S. NAVY MEDICAL NEWS LETTER
U. S. NAVY MEDICAL NEWS LETTER
resuscitation are positioned on the top surface of the
cart. The sterile trays are enclosed in heavy plastic
bags, which obviates the necessity of frequent resteriliza-
tion. Tests have shown the trays to be sterile six
months or longer. These plastic bags (originally new
linen wrappings) were contributed by the hospital linen
room civilian supervisor, and were the subject of a
The AIRWAYS drawer contains oropharyngeal air-
ways, laryngoscopes (infant and adult), endotracheal
tubes, (infant and adult), mouth-to-mouth plastic arti-
ficial respiration airways, nasopharyngeal packs and Fox
The TUBE ADAPTERS drawer contains a set of
labelled multi-colored plastic connectors, as well as ap-
propriate metal and crimped rubber fittings, for ready
attachment of resuscitative or positive-pressure devices
to endotracheal tubes or tracheostomy tubes.
IV. SUPPLIES drawer contains needles, tubing sets,
tourniquets, alcohol sponges, syringes.
The DRUGS drawer (Fig. 3) contains the following
sterile vials and ampules:
saline and water for
Solu-cortef and Solu-
Certain theoretical advantages of such a cart were
augmented by practical advantages which showed them-
selves over the ensuing 12 months:
1. Centralization of emergency supplies in a small,
compact unit freed a space occupied by a large,
cumbersome stock shelf.
2. The use of plastic bags lightened the re-sterilization
chore in the Intensive Care Ward and further dem-
onstrated the concept of prolonged sterile pack-
3. The well-labelled mobile cart, always located in the
same place near the nurse's station, provided a con-
versation piece for the ward staff and became a
practical teaching aid for corpsmen, nurses, and
LCDR Doris M. Sterner NC USN*, the Intensive
Care Ward Supervisor is shown in Fig. 1 at the helm
of the USS LAST CHANCE. HM3 Bennie Trent, also
shown in Fig. 1, was at the time Enlisted-Man-of-the-
Month as a result of his fine performance of duty on
the Intensive Care Ward.
The contents of the DRUGS drawer resulted from
combined suggestions from the Departments of Medi-
cine, Surgery, and Anesthesiology.
• Currently assigned to BUMED on TAD from BUPERS.
Haynes. Lewis L., CAPT MC USN and Harrington, Phyllis, LCDR
NC USNR. Three Years' Experience With Intensive Treatment
anil Recovery Unit in Medicine and Surgery. Military Medicine
125: 398-402, June I960.
FROM THE NOTE BOOK
SUMMARY OF RECENT CHANGES
IN MEDICAL TRAINING PROGRAMS
1. Ensigns (1915) (students in medical school) can
now apply for the Senior Medical Student Program and
the Naval Intern Program by mail. They are no longer
required to visit recruiting stations in person for inter-
views or for physical examinations. Application kits
are mailed to the students from BuMed.
2. Students in the Senior Medical Student Program
now receive the full pay and allowances of an Ensign
during the entire senior year, providing they remain
engaged in school approved elective work. Previously,
students who took elective work in lieu of vacation
were placed on leave, or leave without pay, during such
3. The intern watch schedule in all naval training hos-
pitals has been changed for weekdays and weekends to
one out of three or better. With more free time interns
will have greater opportunities to pursue the academic
aspects of their training.
4. Navy residents are now offered the opportunity to
request retention at their naval hospitals for an addi-
tional year after training, in order to better prepare for
their American Board examinations. This opportunity
is offered where no practice time is required to qualify
for the examination. Favorable consideration will be
given to such requests, depending upon the demands of
the service. — Medical Corps Branch. Professional Di-
U. S. NAVY MEDICAL NEWS LETTER
THREE NAVY DOCTORS WIN AWARDS AT
ARMED FORCES OB-GYN SEMINAR
The Thirteenth Annual Armed Forces Seminar on
Obstetrics and Gynecology, held at Andrews Air Force
Base 26-29 October 1964, was a well-attended, re-
sounding success. The host service, the United Slates
Air Force Medical Corps, is to be thanked and con-
gratulated. Three prizes awarded at this seminar were
won by doctors in the United States Navy Medical
The Robert A. Kimbrough Award for the best resi-
dent paper of the meeting was given to LCDR A. C.
Rolen MC USN. United States Naval Hospital. Oak-
land, California, for his paper on the "Rudimentary
Uterine Horn, Obstetrical and Gynecological Implica-
tions." The Host Award for the paper originating from
work carried out in a small hospital without a teaching
service was won by LCDR Istvan Nyirjesy MC USN,
United States Naval Station Hospital. Naples, for his
paper on "Obstetrical Factors in Mental Development."
Both the X-ray Contest and an Endocrinology Contest,
conducted during the meeting, were won by LT Thomas
C. Rowland MC USN, United States Naval Hospital,
Bethesda. Md., where he is a third year OB-GYN Resi-
dent.— From: CAPT D. M. Shook MC USN. Head
of Training Branch. Professional Division, BUMED.
DR. KAZMIERSK1 FIRST WOMAN
OPTOMETRY OFFICER IN THE NAVY
Anne P. Kazmierski, O. D., a June 1964 graduate of
the Massachusetts College of Optometry, valedictorian
of her class, has accepted an appointment as Ensign.
Medical Service Corps, USNR |W). Dr. Kazmierski is
the first woman optometry ollicer in the Navy and has
already reported to the U. S. Naval Base, Newport,
Rhode Island, for Indoctrination Training. Upon com-
pletion of the course at Newport, Dr. Kazmierski will
receive further indoctrination at the U. S. Naval Hos-
pital. Bethesda, Md., before reporting to her assigned
duty station at the U. S. Naval Hospital. Oakland, Cali-
HOSPITAL CORPSMEN DEMONSTRATE
VALUE OF "INTENSIVE CARE" TRAINING
On 23 September 1964, William C. Cato, Storekeeper
Second Class, attached to the destroyer USS MYLES
C. FOX. was admitted to the Boston City Hospital for
a severely crushed chest and twelve broken ribs, fol-
lowing an automobile accident. He was placed on the
Danger List and required the use of suction apparatus,
respirator, and an emergency tracheotomy to permit
adequate breathing. His condition precluded movement
to the nearby Chelsea Naval Hospital for thirteen days.
The attending physician recommended 24 hour nursing
coverage and asked if the Navy could provide this due
to the shortage of nurses. Chelsea Naval Hospital could
not provide nurses, hut did send three Hospital Corps-
men specially trained in intensive care. The Command-
ing Officer of this hospital was notified and a 24 hour
medical watch by three Hospital Corpsmen from his
Staff was commenced.
The corpsmen were transported from the Chelsea
Naval Hospital to the Boston City Hospital and were
returned after a watch period of approximately ten
SK2 CATO is now a patient at Chelsea Naval Hos-
pital and improving steadily, although still on the Seri-
ous List (as of this writing). The Administrative Super-
visor of the Dowling Building, Boston City Hospital,
expressed gratitude for the competence of these Corps-
men and the professional manner in which they cared
for their patient at all times.
In performing this 24 hour coverage with nursing
care. Jay A. Decatur, Hospitalman, USN; James J.
Merryweather, Jr., Hospitalman, USN; and Leopold F.
Sitnik, Jr.. Hospitalman, USN, demonstrated the time
honored tradition that the "NAVY TAKES CARE OF
ITS OWN".— Submitted by CAPT L. L. Isert MSC
USN, Administrative Officer, USNH, Chelsea, Mass.
AMERICAN BOARD CERTIFICATIONS
American Board of Obstetrics and Gynecology
LCDR James A. Austin MC USN
LCDR John D. Manhart MC USN
American Board of Pediatrics
LCDR Richard L. Rogers MC USN
American Board of Preventive Medicine
LCDR Charles E. Alexander. Jr. MC USN
American Board of Surgery
LCDR Francis E. Banich MC USNR
LCDR John Richard Campbell MC USNR
LCDR Joseph T Mullen MC USN
LCDR William J. Storz MC USNR
COST OF CANCER
Each year cancer deprives the national economy of
50,000 man-years of productivity. Since cancer often
strikes in the later years, many of its victims are highly
trained, skilled personnel. The dollar loss is inestimable.
The annual hospital bill for cancer is estimated to be
CANCER SELDOM CAUSES PAIN IN THE EARLY STAGES
In nearly every cancer case there is a time when the
cancer, if it is detected, may he cured. This is usually
the "silent stage",
U. S. NAVY MEDICAL NEWS LETTER
A Look at Our U.S. Naval Hospitals-
(Third in a Series)
This Naval Hospital is the only one in the Thirteenth
Naval District. It occupies 25 acres of land, situated
on the north central edge and within the confines of
the Puget Sound Naval Shipyard, overlooking the
Shipyard and Sinclair Inlet. The Shipyard adjoins the
City of Bremerton.
The principal buildings of the hospital are of old
English Colonial architecture, of brick, and masonry
construction, in a setting of spacious lawns, flower
gardens, and tall fir trees. From the hospital grounds
may be seen the snowcapped Olympics and other
scenery of beauty.
The site for the Shipyard was purchased in 1891
and on September 16 of that year the "Puget Sound
Naval Station" was established. The first Medical Depart-
ment activity of the station was quartered in the USS
NIPSIC. a small gun boat. On 4 November 1901, the
Medical Department activities were transferred from
the NIPSIC to a frame building ashore. On 25 January
1903, these sick quarters were designated by the Sec-
retary of the Navy as a Naval Hospital. This marked
the commissioning of the first naval hospital in the
During the year 1905, talk of a new hospital had
begun and the present site had been selected. Money
was appropriated by Congress and plans for the new
hospital were completed in 1907. The contract for con-
struction of the hospital, at a cost of $143,971, was
awarded 29 May 1909. The specifications provided for
three buildings: a three-story and basement administra-
tion building: a two-story and basement subsistence
building: and a two-story and basement ward building;
all to be connected by solaria.
These buildings, which today constitute the hospital
proper, were completed on 27 January 1911; however.
as no appropriation had been made for equipment for
the hospital at that time, it was not until 1 January
1912 that the new hospital was occupied.
On 8 November 1920, the Recreation Building, which
was constructed by the American Red Cross, was com-
* Submitted hy CAPT J. E. Gorman, MC USN, Commanding
pleted; and it was turned over to the hospital on 4
December of that year. In June of 1920, the present
WAVE Quarters was completed; but this building was
designated originally as the "Nurses' Quarters." One
wing in 1922 and another in 1923 were added to our
permanent group of hospital buildings.
In May 1923, ground was broken for a new brick
two-story apartment house which was to contain four
apartments for medical officers of the staff; and the
foundation was laid in August 1923 for quarters for
the Commanding Officer. During the year 1925, con-
struction was begun on two sets of quarters designated
as "Pharmacist Quarters." These seven sets of quarters
are the same ones and the only ones the hospital has
A plan for the further development of the hospital
was proposed in 1928. It included construction of ad-
ditional wings to the hospital group, a new Hospital
Corps quarters, and a maintenance utility building
which was to include space for a garage, machine shop,
paint shop, electrical shop, and plumbing shop. The
wing of the permanent group was started in 1931; the
utility and garage building was constructed in 1936;
the Hospital Corps Quarters was completed in 1937:
and in 1939 the wing was added.
On 7 December 1941. it was very apparent that the
hospital must expand and, shortly thereafter, wartime
construction began. In 1942, the Sick Officers' Quarters
and a permanent wing were constructed. Also, three
"temporary" ward buildings (now designated as Ward
O, Ward P, and Dependents' Clinic) were completed.
The laundry building was completed in 1944.
During the war years, 1941 to 1945, a peak patient
load of 1041 was reached on 21 August 1944. During
the Korean Campaign, from June 1950 to July 1951,
there were over 17,000 admissions to the hospital with
amost a half million patient days; and the authorized
bed capacity varied from 750 to 375. Since then the
authorized bed capacity has been reduced from 375 in
1956 to 300 in 1958, 250 in 1959, 225 in 1960, 200 in
1961, 175 in 1963. and 150 in 1964.
Background data of the hospital would not be com-
plete without some history of the City of Bremerton.
U. S. NAVY MEDICAL NEWS LETTER
U.S, NAVAL HOSPITAL—BREMERTON, WASHINGTON
Official U. S, Navy Photograph.
The people of Bremerton have always taken great in-
terest in the Navy. They are highly conscious of de-
pendence upon the civilian employees of the Shipyard
and service personnel, on duty aboard ships and sta-
tions in the area, for support of both business and
Government. A large percentage of the residents are
retired military and civil service personnel.
Bremerton was platted in 1891 and named for the
owner of the greater portion of the land, a Mr. Bremer.
Early Bremerton had few stores, but many saloons and
restaurants. It was familiarly known as "Mud Town."
The growth of Bremerton was slow; and it was not
until 1912 that the first streets were paved. In 1918
and 1927, the City added considerably lo its area and
population by annexations. But World War II caused
a three-fold expansion in residential areas and business
enterprises due to the influx of workers and servicemen;
and the population reached 31.000. There has been
a fluctuation since that time and the population at
present is about 32.000.
The medical and dental officer staff includes special-
ists qualified or certified in the following clinical fields:
Obstetrics & Gynecology
In the para-medical area, our officer staff includes
an optometrist, physiotherapist, pharmacist, and repre-
sentatives of various nursing specialties and administra-
The nursing service includes both military and civilian
The enlisted staff includes all the technicians neces-
sary to support the specialists indicated above as well
as the general duty hospital corpsmen.
The pubic works functions of the U. S. Naval Hos-
pital, Bremerton, were consolidated with those of the
Puget Sound Naval Shipyard on I July 1963. An
Emergency/ Service Work Center is maintained.
A central dictating system of 19 stations with 4
recorders was placed in operation in July of [963.
U. S. NAVY MEDICAL NEWS LETTER
The inventory of the Professional Library has been
expanded to include professional reading material and
references for staff officers other than medical officers
The most recent improvement made was the installa-
tion of a new 3! -station radio paging system.
WORKLOAD DATA— FISCAL YEAR 1964
Inpatients Peak census 165
Admitted: Active duty 1178
Total ~~7~ 3002
Surgical operations 1000
Surgical procedures 3511
Average occupied beds 1 26.4
Average length of patient stay 15.18
Outpatients Active duty 21860
Total - ~ 80616
Immunizations 846 1
Cost per ration $1.1278
PHS CAMPAIGN AGAINST AEDES AEGYPTI
The Public Health Service recently began a 5-year
program to eliminate the yellow fever mosquito Aedes
aegypti from the United States. Congress appropriated
$3 million to support such efforts in fiscal year 1964.
Aedes aegypti is present in Florida. Georgia, Ala-
bama, South Carolina, Texas, Tennessee, Mississippi.
Louisiana, Arkansas, Puerto Rico, and the Virgin
Islands. Although the United States has not had an
epidemic of yellow fever since 1905, the disease is
present in parts of Central and South America, and in
the Caribbean area there have been extensive outbreaks
of dengue fever, which Aedes aegypti also carries.
The eradication program administered by the Com-
municable Disease Center in Atlanta, Ga., is part of an
international endeavor to eliminate the mosquito from
the Western Hemisphere. — Public Health Reports
79(5): 391. May 1964.
TRAINING COURSE FOR CHIEFS OF NATIONAL
Fifteen senior officials from the malaria Services of
countries in the WHO Western Pacific and Eastern
Mediterranean Regions attended a special 10-day train-
ing course in malaria epidemiology at the Malaria
Eradication Training Centre in Manila in June 1964.
Among the trainees were chiefs of malaria eradica-
tion services in Korea, Laos, Sudan, and Viet-Nam.
Other trainees came from China (Taiwan), Japan,
Pakistan, the Philippines, and Sarawak,
The Malaria Eradication Training Centre is a joint
enterprise of the Government of the Republic of the
Philippines, the U. S. Agency for International Develop-
ment, and WHO.— WHO Chronicle 18(9): 358. Sep-
U. S. NAVY MEDICAL NEWS LETTER
EVALUATION OF DIRECT AND
INDIRECT PULP CAPPING
Roland R. Hawes, Joseph Dt'Maggio and Fayez Sayegh,
Eastman Dental Dispensary, Rochester, New York,
Jour Den Res 43(5)Part II: 807-808, Sept-Oct 1964.
This report presents observations lasting from 2 weeks
to 4 years of teeth treated by indirect pulp capping,
direct pulp capping and pulpotomy. Teeth to be
treated were assigned randomly to each treatment
group after clinical examination indicated a deep carious
lesion and a vital pulp. Teeth with symptoms sugges-
tive of pulpitis were not included. Calcium hydrox-
idemethyl cellulose paste was applied over pulp tissue
or residual carious dentin, followed by a base of zinc
phosphate cement or accelerated zinc oxide-eugenol
and a permanent restoration in a single sitting. A total
of 1,048 teeth have been treated, 475 by indirect pulp
capping, 484 by direct capping, and 89 by pulpotomy.
During the period of observation less than 3 per cent
of indirect pulp cappings have resulted in frank clinical
failures, whereas 7 per cent of direct pulp cappings and
19 per cent of pulpotomies have resulted in such clinical
failures. Radiographic evaluation reveals significantly
higher incidence of periradicular radiolucence and ab-
normal primary root resorption in all treatment groups
hut does not significantly reduce the advantage in favor
of indirect pulp capping. This is believed valid even
when 25 per cent ot the successful indirect pulp cap-
pings are disallowed because it is probable that only 75
per cent of these treatments were done on teeth with
exposures. Histological study of 314 teeth, 105 after
indirect and 180 after direct pulp capping, and 29
after pulpotomy also indicated a higher failure rate than
was indicated by clinical and radiographic examination
in all groups. However, these observations do not
significantly reduce the advantage of the indirect pulp-
capping procedure. Simple bacteriological culturing of
dentinal scrapings from selected teeth, reopened at
varying times after treatment, suggests the persistence
of cultivable organisms for prolonged intervals follow-
ing both types of pulp treatment.
Editors note: This article brings strong confirmation
to the policy of the Chief of the Dental Division, Bureau
of Medicine and Surgery, published in U. S, Navy
Medical News Letter 43(12): 22, June 19. 1964.
THE ORAL TISSUES RESPONSE TO
CDR G. H. Green DC USN and LCDR A. D. Sander-
son DC USN. NDS Special Report No. 1, Oct 1964.
This report consists of a thorough review of the pub-
lished literature on the use of ultrasonic instrumentation
in peridontal applications. The authors report that al-
though no significant biological changes in bumans,
monkeys, or dogs have been reported when dental
ultrasonic techniques were applied in the manner cur-
rently in clinical use, numerous investigators have dem-
onstrated that severe, irreversible tissue damage can
occur if considerable care and skill are not exercised.
However, the same findings are also applicable to the
use of the more conventional rotary dental instruments.
The application of constant hard pressure, for instance,
will result in tissue damage whether the application is
by means of the ultrasonic instrument or of low-speed
rotary instruments. Tissue damage will also occur with
either ultrasonic or high-speed rotarv instruments if a
water coolant is not properly used. The damage result-
ing from ultrasonic procedures is considered to be from
the effects of frictional and absorbed heat rather than
from any mysterious energy produced by ultrasound.
Based on this evidence, the authors concluded that
the ultrasonic unit is an excellent adjunct to periodontal
therapy in that it provides more rapid and efficient
removal of gross deposits of calculus than can be at-
tained with hand instruments. The evidence would also
indicate that this equipment could safely be used for
the more rapid removal of supragingival calculus, not
only by properly trained dentists, but also by carefully
trained and supervised auxiliary personnel.
THERMAL CONDUCTIVITY OF
RESTORATIVE MATERIALS AND
Hollenhack, George M. and Sullivan, Maxwell. 5255
Encino Ave., Encirto, Calif., Jour South Calif Den
Assoc 32: 208-213 July 1964. Dental Abstracts 9(10):
632 October 1964.
For years dentists have used various types of cavity
liners and restorative materials in the belief that they
had thermal insulative qualities that would protect the
U. S. NAVY MEDICAL NEWS LETTER
pulp against overstimulation caused by temperature
changes. Although clinical experience indicates that
such cavity liners and materials do protect the pulp
from various types of stimuli, tests of seven restorative
materials and a dental varnish show that the thermal
insulative properties of some materials are less than
A number of special instruments were designed to
ascertain the thermal conductivity of dental varnish,
whale dentin, zinc phosphate cement, zinc phosphate
cement plus 50 per cent (by weight) alloy fillings, zinc
oxide-eugenol, silicate cement, self-curing acrylic resin,
cast gold and amalgam. The apparatus included two
water baths, a pyrometer and thermocouple, and an
instrument which permitted all specimens to be made
in the same dimension with a tubular cavity in the
center of each specimen.
The best thermal insulator of all materials tested
was whale dentin. The next best thermal insulator
was self-curing acrylic resin; however, probably the
deleterious properties of this material would preclude
its use as a thermal insulative material.
Dental varnish — even when used in six coats — does
not seem to possess any significant thermal insulative
Of two amalgam specimens, the specimen with all
possible excess mercury expressed before condensation
had appreciably less conductivity (that is, greater ther-
mal insulative value) than the amalgam specimen pre-
pared to a 50:50 ratio of mercury and alloy without
The addition of alloy filings to the zinc phosphate
cement slightly increased the thermal insulative proper-
lies of the cement.
Cast gold had twice the insulative value of 1:1 ratio
amalgam. Self-curing acrylic resin had twice the in-
sulative value of cast gold.
Editor's comment: There is risk here that a hasty
reader might conclude that use of cavity liners is un-
important. To the contrary, with modern high-speed
cutting including adequate air-water spray, the use of
a varnish to seal the freshly cut dentinal tubules is
highly important. (Stanley, H. R. JADA 63: 749-766.
OBJECTIVES OF DENTAL EDUCATION
Jour Den Education 27(3): 206-207 September 1964.
The Committee on Curriculum of the American As-
sociation of Dental Schools developed the following
statement on the objectives of dental education. These
objectives are reprinted in the News Letter to obtain a
wider reading audience in order to stimulate efforts by
all dental officers toward a total accomplishment of
The colleges, faculties, and schools of dentistry of
the United States and Canada are integral parts of
great university complexes which have as one of their
major objectives the education of men and women for
careers in all of the health services in order best to
meet the national need.
Dentistry, while traditionally maintaining its strong
orientation to medicine and the other health sciences,
has an autonomous system of education whose profes-
sional standards are essentially derived from policies
established by the organized dental profession.
Dental education has strong roots in the basic sci-
ences, and dental teaching is continually enriched by
the services of many persons from other health and
scientific disciplines. Dental education is also premised
on an awareness of the national culture and its heritage.
Thus, by this combination, dental education strives
to give its graduate an understanding of the totality of
human health and personality which will enable him
to fulfill usefully his own career in dentistry.
Dental education recognizes its responsibility in pro-
viding a sufficient number of educated persons so as
to guarantee the maximum levels of dental health serv-
ice which are consistent with the philosophy and re-
sources of the country and all of its citizens. Dental
education believes in the right of all persons to receive
competent health service and. in the national tradition,
the ultimate objective must be to make all health service,
including dental health care, an essential and desired
part of the national standard of living. These challenges
of man and society to the dental profession can be
met only by continuing achievement and renewal of
the following objectives of dental education:
1 . To select students from all walks of life who are
intellectually, morally, and physically qualified for a
career of service to the public in dentistry.
2. To provide an academic environment for these
students which will stimulate and enlarge both their
appreciation and understanding of the philosophic,
social, and intellectual problems of the day.
3. To instill in them the knowledge of the arts and
sciences which will enable them to practice dentistry
so as to provide a competent service to the public and
lifelong satisfaction to themselves.
4. To emphasize the orientation of the dental student
to the physical and biological sciences which the practice
of modern dentistry involves.
5. To provide the clinical training and experience
which are essentia] in the provision of a competent oral
health service to the patient,
6. To foster knowledge of the value, design, and
methodology of dental education so that the dentist may
evaluate research findings and apply them rapidly and
competently in his own practice.
7. To educate auxiliary personnel for the dental pro-
fession so that they will be competent in the discharge
of the duties which are delegated to them by the den-
tist and which are carried out under his direction, thus
U. S. NAVY MEDICAL NEWS LETTER
enlarging the dentist's capacity to render an efficient
oral health service.
8. To offer graduate and postgraduate educational
programs in the basic, dental, and clinical sciences as
a means for enlarging the general competence of the
dentist in all fields of practice and for providing the
advanced education and clinical experience which are
the essential basis for the limitation of practice to den-
9. To make conformance to the letter and spirit of
the principles of ethics an unquestioned part of pro-
10. To insure that teaching is frequently renewed
with new ideas, methods, and personalities to the end
that it meets the changing needs of the student and of
the society in which he will live and serve.
1 1. To enlarge the horizon of particularly well-quali-
fied students so that they will scan the possibility of
future careers in dental research, education, administra-
tion, and dental public health.
12. To develop the potentialities of the dental gradu-
ate for leadership in his profession and his community.
13. To bring conviction to every dental graduate that
his dental education will serve him well only so long as
he refreshes and renews it through lifelong, continuing
PERSONNEL AND PROFESSIONAL NOTES
There are many ways to observe the anniversary of
Christ's birth and the beginning of the New Year. In
whatever manner you celebrate this season, I hope this
one will be the most meaningful and joyful yet. There
is a word in the Greek language, "agape", which means
all that is exemplified by the brotherly love and warmth
for fellow man which come to each individual during
this season. Every year, when this "'agape" spirit makes
each greeting a joy, I hope for a continuation of that
deep feeling throughout the year. Let us make this
our resolution for the coming year.
I wish you a very Merry Christmas and a Happy
F. M. KYES
Rear Admiral, DC. USN
Naval Research Croup Studies Low Temperature Phos-
phorescence of Calcified Tissue. CDR Kirk C. Hoerman
DC USN, Dental Department, Naval Medical Re-
search Institute, National Naval Medical Center,
Bethesda, Maryland, delivered a paper, "Afterglow of
Proteins in Non-Aqueous Media," at the 14th Annual
Instrument Symposium and Research Equipment Ex-
hibit, Clinical Center Auditorium, National Institutes
of Health, Bethesda, Maryland, October 7, 1964.
In a BuMed sponsored research subtask on the or-
ganic components of enamel and dentin, CDR Hoer-
man is using fluoromicrophotometry for quantitative
fluorescence and phosphorescence analyses of hereto-
fore obscure protein molecules of especially low solu-
bility. Collaborating with CDR Hoerman in this re-
search are Miss S. A. Mancewicz and Mr. A. Balekjian,
who are Research Associates of the American Dental
Association, and are at the Naval Medical Research
Institute in the capacity of Guest Scientists. Further
information on this work may be found in "Phosphor-
escence of Calcified Tissue," by Hoerman, K. C. and
Mancewicz. S. A., Arch Oral Biol, August 1964.
Navy Dental Corps Participation at ADA Convention.
The following U. S. Navy Dental Corps contributions
were made to the 105th Annual Session of the Ameri-
can Dental Association held in San Francisco, Cali-
fornia, 9-12 November 1964.
VIDEO TAPES FOR CLOSED CIRCUIT TELEVISION
RADM F. M. KYES DC USN
Chief, Dental Division BuMed
CAPT. H. W. LYON DC USN
NMRI NNMC Bethesda, Maryland
Mass Application of Stannous Fluoride
Cariostasis in Naval Personnel
Factors Affecting Healing of
U. S. NAVY MEDICAL NEWS LETTER
CAPT G. H. ROVELSTAD DC USN
NDS NNMC Bethesda, Maryland
CAPT F. G. GROSSMAN DC USN
NDS NNMC Bethesda, Maryland
CDR K. C. HOERMAN DC USN
NMRI NNMC Bethesda, Maryland
LCDR J. S. LINDSAY DC USN
NDS NNMC Bethesda, Maryland
LCDR W. R, COTTON DC USN
NMRI NNMC Bethesda, Maryland
Need for Clinical Research
Protective Qualities of Maximal-Stimulated Saliva
Emergencies in the Dental Office
Application of Radioisotopes in Pulp Studies
LCDR J. F. HARDIN DC USN
Naval Hospital, Oakland, California
LT K. L. COTTLE DC USN
NavDept Dispensary Wash., D,C.
Temporary Acrylic Bridge and Inlay Technic
CAPT A. R. FRECHETTE DC USN
CO USNDS NNMC Bethesda, Md,
CAPT A. R. FRECHETTE DC USN
CO USNDS NNMC Bethesda. Md.
CAPT F. L. LOSEE DC USN
NavTraCtr Great Lakes, 111.
CAPT F, J. KRATOCHVIL DC USN
NDS NNMC Bethesda, Md.
CAPT P. C. ALEXANDER DC USN
NDC Long Beach, California
Local Anesthesia in Dentistry
Complete Denture Stability as Related to Tooth
Form and Position
Geographic Distribution of Caries, Cancer and
A Complete Denture Technic for
Selecting and Setting-up Teeth
The Periodontium and the Cuspid Protected
CAPTS. S. E. TANDE DC USN and
J. B. LEPLEY DC USN
NDS. NNMC, Bethesda, Maryland
MOTION PICTURE FILM FESTIVAL PANELIST
CAPT S. E. TANDE DC USN, NDS, NNMC, Bethesda, Maryland
U.S. NAVY DENTAL TRAINING FILMS (PREMIER SHOWING)
MN-9727 Peridonta! Disease: Prevention and Early Treatment
MN-9739 Immediate Denture Service: Coordinated Management
MN-9868 Preventive Dentistry: The Prevention of Oral Disease
MN-9773 Surgical Endodontics
MN-9774 Intraoral Roentgenography: Improved Equipment and Techniques
RADM E. G. F. POLLARD DC USN, Director Dental Activities, FIFTH Naval District, served as Delegate and
CAPT J. J. DEMPSEY DC USN. TWELFTH Naval District Dental Officer, as Alternate to the ADA House
U. S. NAVY MEDICAL NEWS LETTER
The following dental officers attended the indicated Reference Committee Hearings:
CAPT D. C. MAXFIELD DC USN Dental Trade and Laboratory Relations
NavSta San Francisco, California
CAPT R. A. MIDDLETON DC USN
NavHosp Oakland. California
CAPT F. I. GONZALEZ JR DC USN
NAS Alameda, California
CAPT A. R. FRECHETTE DC USN
CO NDS NNMC, Bethesda, Maryland
CAPT M. E. SIMPSON DC USN
NSYD San Francisco, California
CAPT M. A. MAZZARELLA DC USN
MedResUnit 1 Univ. (Oakland) Calif.
Hospital Dental Service
Federal Dental Services
Dental Research and Therapeutics
Navy Dental Officers Participate in Periodontal Meeting.
Three Navy dental officers from the National Naval
Medical Center, Bethesda, Maryland, participated in
the Fiftieth Annual Meeting of the American Academy
of Periodontology held in San Francisco, California,
4-7 November 1964. CAPT H. W. Lyon DC USN,
NMRI, presented an essay entitled "Influence of Bone
Marrow Implants." Captains T. R. Hunley and F. J.
Kratochvil DC USN, NDS, presented a clinic on Sup-
porting the Treatment of Advanced Periodontal Disease.
Navy Presentation Before International Dental Society.
CDR G. H. Green DC USN, NDS, NNMC. Bethesda.
Maryland, served as panelist for a conference on Kera-
totic Lesions of the Oral Mucous Membrane before
the Second Annual Conference of the International
Academy of Oral Pathology held in San Francisco,
California 7-9 November 1964. He also monitored
an exhibit entitled "Exhibit on Tongue Lesions" which
was prepared by CAPT H. H. Scofield DC USN. LT
COL J. Corny n DC USAF, and CDR Green at the
Armed Forces Institute of Pathology, Washington, D.C.
Navy Participation in Conference on Military Dentistry.
CAPT V. J. Niiranen DC USN, Staff Dental Officer,
Commandant, U. S. Marine Corps, served as Pro-
gram Chairman for the Maxillofacial Meeting of the
International Conference on Military Dentistry held
in San Francisco, California, 7-14 November 1964.
CAPT J. B. Lepley DC USN, NDS, NNMC, Bethesda,
Maryland, presented an essay entitled "Special Pros-
theses and Materia! in Support of Medical Specialties,"
The conference was sponsored by the Armed Forces
Dental Services Commission of the Federation Dentaire
Dental Service Report, DD Form 477— 1 . Responsible
dental officers are reminded that the Dental Service
Report. DD Form 477-1, Equipment and Facilities
Supplement, shall be submitted on 1 January each year
in accordance with MANMED Art. 6-151. The original
shall be addressed to BUMED (Code 612), one copy
to the Field Branch BUMED, 3rd Ave. and 29th
Street, Brooklyn, New York 11232, and one copy
(unless otherwise directed) to the reviewing officer.
Navv Dentist Receives Award for Professional Paper.
CAPT P. J. Boyne DC USN. USS BON HOMME
RICHARD, was awarded a prize recently for a pro-
fessional paper by the American Society of Oral Sur-
geons. The award was made at the Annual Session of
the society held in Las Vegas, Nevada 3-7 Nov 1964.
Naval Dental Officer is Guest Speaker at Meeting of the
Guam Dental Society. LCDR D. M. Grove DC USN.
U. S. Naval Dental Clinic, Guam, M. I., recently pre-
sented an illustrated lecture entitled "Full Denture
Techniques" before the Guam Dental Society at Ander-
son Air Force Base. The Society is a joint study club
consisting of all military and most civilian dentists on
Guam. Its purpose is to further professional knowledge
by regular appearances of guest clinicians. Dr. Grove
was elected President of the Society last July. Other
elected officials include: CAPT Foreman KAN DC
USAF, Secretary-Treasurer and LT O. B. Walker DC
USN, U. S. Naval Dental Clinic. Guam, M. I„ Program
Naval Reserve Dental Officers Meet. CAPT R. F. Tuck
DC USNR. Head, Dental Reserve Branch, BUMED.
U. S. NAVY MEDICAL NEWS LETTER
served as Presiding Officer for the Naval Military
Seminar held in San Francisco, California, 9 November
1964. RADM J. McN. Taylor USN, Commander
Western Sea Frontier and Commandant TWELFTH
Naval District, presented a talk titled "A Look at the
World Situation Today." CAPT F. G. Grossman DC
USN NDS, NNMC, Bethesda. Maryland, presented a
paper on "The Naval Dental Corps' Preventive Den-
tistry Program." The film. Intraoral Roentgenography
— Improved Equipment and Technique was shown
during the meeting.
Naval Dental Reserve Selection Board Commencing
Dates. 5 January 1965 — Flag Selection Board will act
as continuation board for Captains, as there are no
vacancies in Flag Billets at this time; 2 March 1965 —
Selection Boards meet for selection to the rank of Cap-
tain and Commander from their respective eligible
fields; 20 April 1965 — Selection Board meets for selec-
tion to the rank of Lieutenant Commander from Lieu-
tenants eligible for selection.
DENTAL TECHNICIANS SELECTED FOR PROMOTION
Congratulations to the following dental enisted personnel upon their selection for promotion:
Ensign MSC (Supply and Administration) USN
Francis S. Connors (DTI)
Jerry D. Galbreath (DTI)
M. B. Quinn
J. A. Pogas
W. W. Lee
A. R. Howell
R. L. Shell
W. R. Sickles
P. M. West
F. B. Grisson
J. P. Turan
J. J. Mulligan
C. W. Farthing
C. W. Finley
D. A. Johnson
NavDentClinic Brooklyn, New York
COMNINE Great Lakes, Illinois
Advancement to DTCM Effective 16 November 1964
USS Coral Sea
SUBBASE New London, Connecticut
Advancement to DTCS Effective 16 November 1964
NavSta Charleston, South Carolina
NavExamCtr Great Lakes, Illinois
NDC Pearl Harbor, Hawaii
2nd MarDiv FMFLANT
NDC Washington, D. C.
NDS NNMC Bethesda, Maryland
Advancement to DTCA Effective 16 November 1964
Naval Air Station Corpus Christi, Texas
Naval Air Station Olathe, Kansas
Naval Training Station Great Lakes, 111.
Marine Corps Air Station Cherry Point. N. C.
Advancement to DTCA Effective 16 January 1965
NavMedResInst NNMC Bethesda, Maryland
Marine Corps Recruit Depot San Diego, Calif.
THE TEST THAT SAVES WOMEN'S LIVES
The "Pap" (short for Papanicolaoa) smear, a pain-
less, inexpensive cancer test done in the physician's
office, is one of the most sensitive and reliable weapons
in the arsenal of modern medicine for detecting cancer
of the uterus at a time when it is most curable. Yet
about 70 per cent of the American adult female popu-
lation have never had this test, and 40 per cent have
never even heard of it. Have you?
CANCER KNOWS NO BOUNDARIES
"Cancer is not American, or British, or Russian, or
African. It is international, worldwide, lawless, fence-
less. Fighting it must be the common concern of all
mankind . . . Cancer is not bothered by passports or
petty politics. It can find a billet in any home, any-
— Dr.Harry M. Nelson, Past President
American Cancer Society
U. S. NAVY MEDICAL NEWS LETTER
AVIATION MEDICINE SECTION
MEDICAL ASPECTS OF SPACE FLIGHT*
By Captain Frank B. Voris MC USN, National Aeronautics and Space Administration
Publication. U. S. Government Printing Office, Washington, D.C., 20402.
About the author:
Capt. Frank B. Voris, USN, at the time he wrote
this article, was Chief of Human Research in the Bio-
technology and Human Research Division of NASA's
Office of Advanced Research and Technology.
He received his Doctor of Medicine degree from the
University of Illinois and served as resident surgeon
at the St. Francis Hospital, Miami Beach, Fla. From
1937 to 1941 he was engaged in private surgical prac-
tice at Miami Beach.
In September 1941 he was called to active duty in
the Medical Corps of the U. S. Navy. In July 1942,
upon completion of a course in aviation medicine at
Pensacola, Fla., he was designated a navai flight sur-
geon. In 1947, upon completion of flight training, he
was qualified as a naval aviator. He was promoted to
the rank of captain in July 1955.
Captain Voris has served as head of the Special Ac-
tivities Branch of the Aerospace Medical Association,
and in I960 was Vice President for Aviation Medicine
of the American College of Preventive Medicine.
In 1952 he was awarded the Founder's Medal of the
Association of Military Surgeons of the United States;
and in September 1962 he received from the American
Medical Association a Special Aerospace Medicine
Honor Citation for service to the Nation and to medi-
cine in the successful orbital flights of the American
Frank B. Vori<, M. D.
Chief. Human Research
Biotechnology and Human Research Division
Office of Advanced Research and Technology.
MANNED SPACE FLIGHT
NASA's manned space flight program includes Proj-
ects Mercury, Gemini and Apollo, in that order — and
with increasingly complex medical aspects to come in
future long-range (lights.
Project Mercury was primarily an engineering ex-
ercise. For flights up to three orbits it was a fully
automatic system, flown to test aerodynamics theory
and numerous engineered subsystems, including those
designed to support a man in space. The testing of
man and his ability was a secondary aim of these flights.
In passing from three-orbit flights to the six and one-
half orbits of Waller Schirra and the 22 orbits of Gor-
don Cooper, we went beyond the original engineering
test concept to a man-machine combination test mis-
sion. To extend Project Mercury flights beyond three
* The original brochure contains ei^hc photographs illustrating
essential items in the text, and is for sale by the Superintendent
of Documents, U. S. (iovernment Printing Office. Washington. D. C.
2(1402 — Price 15 cents. It is highly recommended. — Editor
* Now assigned to duty in [he Bureau of Medicine and Surgery in
the Research Development and Astronautical Sections of the Re-
st ir'h Division, and as Director of the Astronautu.il Division of
U, S. NAVY MEDICAL NEWS LETTER
orbits, man was required to be in the vehicle. Beyond
three orbits the system is no longer fully automatic;
it is a man-machine combination in which the man
assumes a most important and vital role. For future
manned space flights, man and machine will be treated
as a single entity, each depending on the other for suc-
cessful mission completion.
In Project Gemini two men will ultimately orbit the
earth for periods up to 2 weeks. Gemini will be a test
bed for Project Apollo. Here we can test equipment,
train and observe astronauts, and develop techniques
in space rendezvous and docking.
Project Apollo calls for extended earth orbital flights
and for landing men on the surface of the moon during
this decade. It is planned that two men will land and
explore the surface of the moon, to a limited degree,
spending up to 4 hours at any one time, outside their
Future plans for man's space explorations go beyond
the time duration and distance limitations for Project
Apollo. We look to men being in space vehicles for
periods over a year or living in permanent lunar or
planetary bases for even longer periods. Once orbital
stations and laboratories are in operational use. it is
conceived that crews will be relieved periodically every
30 days or so. During the changing of crews and ob-
servers, the orbiting spacecraft will be resupplied with
food, oxygen, fuel, and other necessities. This "luxury"
of relief and resupply will probably not be available for
interplanetary flights such as to Mars or perhaps Venus.
There is need for research into the human physiological
response and performance required for and found dur-
ing such long-term flights,
MAJOR HUMAN RESEARCH PROBLEMS
When we stop to think about it, we realize that for
the first time we are now placing man in a hostile en-
vironment in which there is literally nothing to help
support him. In submarines we may use water to good
advantage; in high attitude jet aircraft we scoop up
enough air to compress for man's use; in the Antarctic
man is able to use much of the natural environment to
exist. In space, however, only the energy of the sun
is available for man and this only partially supplies the
power he requires. He must take his gaseous atmos-
pheres and pressures and his food, water, and energy
supplies with him, or perish.
SUPPLYING RESPIRATORY REQUIREMENTS
Let us consider our most obvious problem, that of
supplying man with his respiratory requirements. As in
Mercury, in Project Apollo we plan to use pure oxygen
at a pressure of 5 pounds per square inch. The Rus-
sians have used 14.7 pounds per square inch with ap-
proximately 20 percent oxygen on all their flights. Al-
though our 100 percent oxygen systems have proven
adequate, and hopefully they will continue to be so, I
U. S. NAVY MEDICAL NEWS LETTER
fee! that for our advanced missions of over 14 days we
will be required to go to a mixed gas system of more
than 5 pounds per square inch. The reasoning behind
this is the results of research on oxygen toxicity, the
development of atelectasis in subjects on 100 percent
oxygen, and the results of studies in radiation effect
on living tissue that is saturated with 100 percent oxy-
Because of restrictive weight penalties, we are re-
quired to reclaim all the unused oxygen from the astro-
nauts' expired breath. As of now, and for our future
flights, the carbon dioxide and trace contaminants must
be removed chemically from the expired oxygen prior
to re-use by the astronaut. For more advanced systems
this carbon dioxide will be broken down into carbon
and oxygen. The carbon will be used for radiation
shielding; and, of course, the oxygen will be used for
the gaseous atmosphere.
The reclaimed water may also be hydrolyzed produc-
ing hydrogen which can then be combined with the car-
bon to produce methane, which can be further synthe-
sized to form formaldehyde and finally various sugars.
Again, the oxygen will be used for breathing. Thus,
future vehicles and planetary bases will utilize each
atom of material available, producing usable oxygen
and edible sugars from the carbon dioxide and water
produced by the body metabolism of man.
In using a mixed gas system, we must find an inert
gas with a low diffusion factor that is non-toxic, light,
and easily obtained, handled and stored. We know
something about the physiological effects of nitrogen;
we know less about helium and very little about argon,
neon, and other rare inert gases. It appears reasonable
at this point to predict that nitrogen will be chosen for
our early extended flights. However, our on-going re-
search into these other gases may prove this view
To protect the present-day astronaut from the effects
of losing his capsule pressures, we place him in a full
pressure suit. Should his capsule be struck by a meteo-
roid or in any manner lose its atmospheric integrity,
the astronaut without his suit would be exposed to a
vacuum. The dissolved gases within his blood and
body tissue would immediately be released and he would
suffer death within a very short time.
The full pressure suit is air impervious and it fully
encapsulates the man. When the capsule pressure drops
below 5 pounds per square inch, the suit valve closes
and air pressure within the suit supplies enough pres-
sure to keep the man fully surrounded by 5 pounds of
air pressure. The suit is a necessary safety device, but
it is cumbersome when under pressure; and, under nor-
ma! operation conditions it requires a high ventilation
flow of dry cool air to keep the astronaut from suf-
fering from heat and his own sweat. Incidentally, the
full pressure suit is a primary piece of fire-fighting
equipment. In space the most expeditious and safest
means of putting out a fire within the capsule is to open
the capsule, thus creating a vacuum within. Without
oxygen the fire dies. The suit keeps the man at 5
pounds per square inch.
Here again, it is my personal opinion that we cannot
keep our future astronauts in the present full pressure
suit for prolonged periods. We are hard at work trying
to devise methods of affording the astronauts the safety
features of a full pressure suit with the comforts and
facilities of a "shirt-sleeve" environment. This is no
Furthermore, future space operations require extra-
vehicular maneuvering of men in free space as well as
on lunar and planetary surfaces. Here the man will be
required to work in varying degrees of a weightless
state, and thus in reduced or frictionless environments.
He will be subjected to extremes in temperatures, brilli-
ant light or extreme darkness, and, of course, to radia-
tion hazards. We must devise and provide adequate
protective extravehicular suits for individual space men
with reliable independent life support systems and self-
PROBLEMS OF ACCELERATION FORCES
Another major area of concern to the space surgeon
is that of acceleration. In order to withstand the ac-
celeration forces required to boost a vehicle into orbital
or escape speeds, we place man on his back facing the
line of flight. Thus, the acceleration forces during the
boost phase are exerted on him and his organs trans-
versely from chest to back. Should he be in a seated
position, the acceleration forces would act from his
head to his buttocks. Pressures would build up within
the cardiovascular system that would prevent sufficient
blood from reaching the brain, and thus cause uncon-
sciousness. Prolonged ischemia can cause permanent
cerebral damage. In a horizontal position the cardio-
vascular system becomes a horizontal pumping system.
Thus, the blood cannot pool in dependent organs and
limbs. There is little build-up of hemodynamic pres-
sures, and the heart has the capacity to pump blood into
the brain. The period of useful consciousness is greatly
extended during prolonged acceleration forces.
Each astronaut has a custom-made, form-fitting
molded couch in his vehicle. By this fact, when ac-
celeration forces increase the body weight, these ex-
cessive forces are distributed equally throughout nearly
one-half his entire body surface. He can remain rela-
tively comfortable through prolonged high G force
phases of flight.
PROBLEMS OF WEIGHTLESSNESS
Another environmental factor of considerable con-
cern that is receiving a great deal of scientific attention
Once through the acceleration phase, the astronaut
suddenly finds himself weightless. Under this condition
nothing has weight. Thus, the blood within the blood
vessels is as weightless as any other portion of the body
or anything in the vehicle. Weightlessness is a phe-
nomenon caused by the speed of the vehicle counter-
acting the gravity force of the earth. At a speed of
17,500 miles per hour, the vehicle will rotate about
the earth at approximately 100 miles of altitude in a
relatively fixed orbital path.
Theoretically, should the earth's gravitational pull
suddenly cease, a speeding orbital vehicle would shoot
away from the earth in a straight line tangential to the
earth. The balance between the speed of the vehicle
and the earth's gravitational pull is a delicate one. The
firing of the retrorockets slows the vehicle only about
350 miles per hour, but this is enough to allow gravity
to take over and bring the vehicle gradually toward
the earth. Once the capsule begins to contact the at-
mosphere, the resistance to the speeding vehicle in-
creases and the deceleration rate increases.
To date, effects of weightlessness have not been
detrimental to man in space. However, we have reason
to believe that over longer periods of time weightless-
ness may take its toll in producing adverse physio-
logical effects. Most of us are well aware of the reac-
tion of well and healthy individuals who have been re-
stricted to absolute bed rest for prolonged periods.
First, upon rising they become faint, developing varying
degrees of syncopal symptoms from blanching to loss
of consciousness. Secondly, should they be kept on
their feet, they develop dependent edema, or swelling
of the feet and ankles. The same effect has been noted
in subjects who have been fully submerged in water
during studies of neutral buoyancy. The cardiac action
and capacity have changed and cannot react quickly to
the alterations in the hemodynamics of the changed po-
sition of the body. Again, the characteristics of the
peripheral vascular system have changed. The arteries
and veins of the lower portions of the body do not ac-
commodate the blood, and the tissues become edema-
tous. The kidney function is altered, with noticeable
increase in urine output.
A very serious effect of prolonged bed rest and
neutral buoyancy is that of a shift in the body metabo-
lite balance. The major shift is a marked increase in
blood calcium which is subsequently excreted by the
kidneys. This increase is due to a rather early and
definite demineralization of the hones. This factor has
been noted in examining the astronauts after Project
Mercury flights. We do not know the mechanisms that
cause these physiological changes in the basic functions
of the body. We have no idea how far the cardiovascu-
lar system adapts to the dynamics of weightlessness or
how great demineralization becomes before the process
slows or stops, if in fact it does stop.
With the thought that bed rest without exercise
caused the aforementioned changes, the experimenters
U. S. NAVY MEDICAL NEWS LETTER
had half of the subjects do vigorous exercises while re-
maining fiat on their backs. The exercise worked won-
ders for the muscular system, but the results on the
cardiovascular system and the metabolic processes were
the same as for those who did no exercising.
What can this mean to the astronaut if these changes
progress over several weeks or months of weightless-
ness? First, the cardiovascular system and the bony
structure of the body may fail upon being subjected to
the relatively prolonged and high acceleration forces
experienced during reentry. Loss of consciousness,
myocardial insufficiency, or complete cardiac failure
may result. Fractures may result from the loss of ade-
quate bone structure. We may well be required to place
a successfully returned astronaut in a rehabilitation cen-
ter where he will gradually regain bodily activity and
learn to walk again. The one-gravity field we know
and react to so well here on earth will be strange to the
A third major hazard to which we have turned con-
siderable attention is that of radiation. The effects of
certain radiations are well known to us. We have de-
veloped equipment to produce a variety of radiation
energies and particles and have exposed biological
specimens to these hazards. However, we still know
very little of the biological effects of mixed radiation
energies and the extent of effects due to secondary
energies received by occupants in spacecraft. Much
more work must be done to develop better passive and
active shielding systems for future flights.
During Projects Mercury and Gemini and through
the early Apollo flights very little, if any, radiation
hazards will have been encountered. We are interested
in the heavy primary strikes from galactic sources but
as these flights are not scheduled to meet the Van Allen
Belt concentrations, there is little concern for the astro-
naut. The later Apollo nights will be required to pass
through the earth's geomagnetic fields and into outer
space where the full energies of the sun and its solar
flares will be met. We have not been successful in fully
mapping this space for its radiation hazards nor have
we accurately defined the concentrations and varieties
of the mixed radiation energies to be met.
Additional hazards will result when men leave the
protective shell of the vehicle for extravehicular work
in free space or on the lunar surface. Added biological
effects of radiation exposure may result from using 100
percent oxygen during these extravehicular operations.
Future plans call for active shielding systems that
may well place a man in a vehicle surrounded by a
strong electromagnetic field that will repel or trap the
particles much as our own earth's geomagnetic fields
do. What effects these high-magnetic fields have on
man is still unknown. Another facet of study concern-
ing electromagnetic fields involves the biological effects
of null or low field forces and, of course, the effects
on living tissue passing through varying magnetic field
forces. We are extensively studying animals and men
in altered magnetic fields and hope to have definite
answers in the near future.
CHANGE OF COMMAND CEREMONY AT
U. S. NAVAL AVIATION MEDICAL CENTER
On 4 November 1964 in a formal military Change of
Command Ceremony, RADM James L. Holland, MC
USN relieved RADM Langdon C. Newman, MC USN
as Commanding Officer of the U. S. Naval Aviation
Medical Center, Pensacola, Florida.
Present on the Reviewing Stand were: Vice Admiral
A. S. Heyward, Jr., USN, Chief of Naval Air Training;
Rear Admiral Daniel F. Smith, USN, Chief of Naval
Air Basic Training; Rear Admiral Robert B. Brown,
MC USN, Deputy and Assistant Chief of the Bureau of
Medicine and Surgery; Rear Admiral Herbert H.
Eighmy, MC USN, Assistant Chief for Personnel and
Professional Operations, Bureau of Medicine and
Surgery; and other military and civilian dignitaries.
Rear Admiral Holland recently was assigned as Fleet
Surgeon on the Staff of the Commander in Chief.
United States Pacific Fleet. Rear Admiral Newman's
next assignment will be in the Bureau of Medicine and
Surgery as Assistant Chief for Research and Military
CANCER MUST BE TREATED EARLY
Early diagnosis and treatment holds the best hope
for cure. Two ways to protect yourself: Have an an-
nual health examination and be alert to cancer's seven
danger signals. Get copies of the seven danger signals
by calling or writing to your local American Cancer
DIET COUNSEL FOR HOMEBOUND
In Newark, N. J., a nutritionist, provided through
the Visiting Nurses Association, teaches homebound
patients how to select and prepare foods for new or
modified diets. The fee charged for the service is ad-
justed for patients unable to pay full or partial costs.
—Public Health Reports 78( 12) : 1060, December 1963.
U. S. NAVY MEDICAL NEWS LETTER
LCDR RICHARD A. MILLINGTON, MC USN,
RECEIVED THE NAVY COMMENDATION
MEDAL FROM THE SECRETARY OF THE
NAVY ON 19 OCTOBER 1964 FOR SERVICE
AS SET FORTH IN THE FOLLOWING
"For meritorious achievement while serving with Air
Development Squadron SIX (VX-6) on the flight from
Capetown, South Africa to McMurdo Station, Antarc-
tica on 30 September-October 1963. As a special crew
member of a ski-equipped LC-130F Hercules aircraft,
LCDR Mitlington, through his professional skill and
meticulous attention to detail, contributed materially to
the successful completion of this pioneering and trail -
blazing, nonstop flight of 4,700 miles over unknown
waters of the South Atlantic Ocean and the uncharted
wastes of Antarctica. His fortitude and devotion to
duty were in keeping with the highest traditions of
the United States Naval Service."
CASES OF BOTULISM— HIGHEST
SOURCE: 1899-1949— Meyer, K. F. and Eddie, B.
•'Fifty Years of Botulism in the United
States and Canada," George Williams
Hooper Foundation, University of Cali-
fornia, San Francisco. 1950-1963 — State
Reports received by NOVS and CDC.
Four cases of botulism were reported from Cali-
fornia recenty making the cumulative total of cases
reported thus far in the United States this year 15,
compared to 34 for a similar period in 1963. The 4
cases from California represented an outbreak attributa-
ble to home canned peppers. California leads all other
States in the number of cases reported this year, with
a total of 7.
The majority of cases in 1963 were due to com-
mercial products whereas this year, all cases have been
attributed to the consumption of home canned products.
No cases of type E botulism have been reported to
date this year.
The following table presents the number of cases of
botulism outbreaks for the 10 highest years since 1899.
NAVY NURSE GIVEN MEDAL FOR
PERFECT SCHOOL RECORD
Boulder, Colo. — Lieutenant Phyllis J. Elsas, Navy
Nurse Corps, has received the University of Colorado's
Distinguished Service Medal for outstanding perform-
ance of obtaining a perfect scholastic record.
She is the only person in the history of the school to
graduate with perfect marks.
The presentation was made here during a Navy Day
review at the university. (AFPS-Nov, 8, 1964)
(BAGGING TO REDUCE CROSS INFECTION)
A new technic of bagging thermometers to reduce
cross-infection in hospitals has been developed in Den-
U. S. NAVY MEDICAL NEWS LETTER
mark. Thermometers are sterilized by immersion in
1:1000 Zephiran (benzalkonium) chloride solution for
two hours. After washing and drying each thermometer
is placed in a small cellophane bag. The ward nurse
hands the bag to the patient who removes the thermom-
eter, takes his temperature, and replaces the ther-
mometer in the bag. The nurse reads the thermometer
through the cellophane. The bagged thermometer is then
returned to the central sterilizing room. Thus, no one
in the ward except the patient handles the thermometer
between one sterilization and the next. — Med. News
(London, Eng.), No. 102, Sept 18, 1964.— Clin-Alert®,
No. 302, Nov 3, 1964 (by permission).
DIRECTOR, NAVY NURSE CORPS'
The Chiefs of Nursing Service of all naval hospitals
within the continental limits of the United States at-
tended a 3 day Navy Nurse Corps Director's Confer-
ence from 14-16 October at the National Naval Medi-
cal Center, Bethesda, Maryland. Captain Ruth A.
Erickson, NC, USN, convened the meeting for the
Senior Nurse Corps officers. Captain Dorothy P. Mon-
ahan, NC, USN, Deputy Director, moderated the pro-
Rear Admiral C. B. Galloway, MC, USN, Com-
manding Officer of the National Naval Medical Center,
welcomed the senior nurses during the opening session.
Following this, Rear Admiral Robert B. Brown, MC,
USN, Deputy Surgeon General, addressed the con-
Captain Erickson spoke to the senior nurses through-
out the program in areas concerning the theme of the
meeting, "Today's Action Determines Our Tomorrow."
She presented a profile of the Corps; discussed an on-
going research project on retention of nursing person-
nel; explained personnel policies for assignment, edu-
cation, and advancement of nurses; probed problem
areas; and voiced her concern about the current critical
shortage of nurses. Captain Erickson also informed the
Chief Nurses of continuing projects and activities that
will be of assistance to nursing services and the Nurse
Other highlights of the meeting included various
presentations by selected Chiefs of Nursing Services,
by members of the Education and Research Branches
of the Naval Medical School and by members of the
Nursing Division staff. The individual speakers inter-
wove subjects on utilization of nursing personnel, tele-
vised programmed instruction for nurses, counseling
and guidance techniques, management, and research as
areas of action being undertaken today that will serve
to improve the Nurse Corps tomorrow.
Other distinguished guests included Dr. D. George
Kousoulas, Dr. John C. Lang, and Dr. Esther Lloyd-
Jones. Professor Kousoulas, a faculty member of
Howard University, discussed "Perspectives of the Com-
munist Movement Today." Dr. Lang, Head of the
Curriculum and Instruction Branch, Bureau of Naval
Personnel, Washington, D. C, spoke on "in Navy Edu-
cation and Training." Professor Lloyd-Jones, Head of
the Department of Guidance and Student Personnel
Administration, Teachers College, Columbia University,
New York, discussed "Programming for Guidance and
Counseling in Nursing Service." — Nursing Division,
THE VALUE OF A NAVY CAREER*
By LCDR J. P. Kirsch, MSC USN**. From Supple-
ment Prepared by the Great Lakes BULLETIN in
Celebration of NAVY DAY, 1964.
Value is a relative term, therefore it must be related
to specific items to have real meaning.
First, when related in terms of money (which is un-
derstandable to everyone) the value of a Navy Career
can be measured in dollars and cents. To a young man
entering the Navy as a seaman recruit and who is will-
ing to work and study hard for 30 years — it can equal
an investment of more than $150,000 at 4% per year.
In other words, he can retire at $570 per month for
Second, when related to education — it can mean
learning a profession by taking advantage of the Navy's
A, B, and C schools. It can mean gaining a high
school diploma or a college degree at night under Navy
sponsorship and with Navy financial aid. It can mean
full time college training under the NESEP program or
even education at the Naval Academy. And for the
ones who are real energetic, it can mean a master's
degree through postgraduate school in the Navy or a
civilian university at Navy expense and at full pay.
Third, when related to prestige — it can mean rising
from the average status of a recruit through the en-
listed ranks to become a commissioned officer. This
can be done through many different programs — MSC,
NESEP, Warrant to LDO, or Naval Academy. When a
man has worked his way up through the enlisted rates
and into the commissioned officer ranks, he has gained
the respect of his contemporaries and seniors alike —
he has prestige that can be questioned by no man.
Fourth, when related to security — the value of a
Navy career is knowing that you have a job and a pay
check for as long as you are willing to work hard and
put forth your best, knowing your health will be pro-
tected and that you will receive free medical and dental
care — while receiving full pay — by the very best medi-
cal and dental personnel, knowing that your wife and
children will receive medical care at military or civilian
hospitals, and knowing that, if adversity strikes, "The
U. S. NAVY MEDICAL NEWS LETTER
Navy takes care of its own" through its allied organiza-
tions. And finally, you know that you can retire after
20 years of service if you so desire.
Fifth, when related to patriotism — the value of serv-
ice to our country is intangible and cannot be meas-
ured — yet it is the most important of all. Learning love
for our country through service in peace and war has
a way of going deep inside of a man. A love which
puts a lump in his throat or a tear in his eye every
time he sees our flag raised or hears our National
Anthem played. These values cannot be bought or sold
— money does not affect them, they are instilled through
the esprit de corps of naval service.
Do these values sound a little far fetched?
Seaman Recruit to Lieutenant Commander
$570 a month for life at retirement
A college education
Prestige as an officer
Personal health security
Family health security
An intense love of our country through service in
protecting and perpetuating the greatest country
in the world.
A little unbelievable? A touch of Horatio Alger?
Perhaps . . . but I can prove it — it happened to me!
* Nine winners of the Navy Day Essay Contest at the U. S. Naval
Training Center, Great Lakes, Illinois, were awarded their prizes
Friday, Oct. 16 by Captain E. G. Sanderson, USN, Center Com-
All center personnel and their dependents, over
for the contest.
The contest consisted of three categories. "The Value of a Navy
Career" was category one in which officers and enlisted men on
their second tour of duty were eligible. "Why 1 Chose The Navy"
was category two which included first tour personnel, both officer
and enlisted. "Challenges Facing Navy Dependents" was category
three which included Navy dependents.
First place winner in category one was Lieutenant Commander,
J. P. Kirsch, NEC. LCDR Kirsch won a 16-inch portable TV.
Second and third place prizes went to G, S. Johnson, CS2 and W, H.
Arthur, HM3. They received portable radios.
In category two. first prize went to Elizabeth Martin. SA. Wa\e
Admin; she was awarded an RCA transistor radio. Second and
third place winners were Lieutenant (jg) A. P. McLaughlin of
DPWO and B. J. Wilson, SA, Public Works. Both were awarded
a six-transistor radio.
"Challenges Facing Navy Dependents," the third category, was
won by Mrs. Patrick C. Racey. Mrs. Racey was awarded an auto-
matic washer. The second place prize was a stereo phonograph
awarded to Miss Anita Anthony. Mrs. G. M. Molm won a radio.
An honorable mention was given to Miss Kamona Federle, a 12-
year-old dependent. Captain Sanderson commended her on the
thought and originality she showed for such a young girl.
** Lieutenant Commander Kirsch, a resident of Mundelein, Illinois,
and a native of Hills, Minnesota, is currently attached to the Naval
Examining Center. Happily married, and the father of three children.
He admits, in his essay, to being a 30-year career man.
DR. WALTON JONES NAMED ACTING
HEAD OF NASA BIOTECHNOLOGY
Dr. Walton L. Jones, Jr., became Acting Director of
the Biotechnology and Human Research Division at
Headquarters, National Aeronautics and Space Ad-
ministration, effective Oct. 26. He succeeded Dr. Eu-
gene B. Konecci who resigned to join the staff of the
National Aeronautics and Space Council,
The assignment was announced by Dr. Raymond L.
Bisplinghoff, NASA Associate Administrator for Ad-
vanced Research and Technology.
The Biotechnology and Human Research Division is
concerned with research and advanced technology for
the support of man in aeronautical and space flight and
the means to assure his capabilities in extended flights.
Dr. Jones joined the division May 5, and later suc-
ceeded Dr. Frank B. Voris as Head of the Human Re-
search Branch. Dr. Jones is an active duty Captain
and Flight Surgeon in the U. S. Navy Medical Corps.
Before coming to NASA he was Director of the Avia-
tion Medicine Technical Division of the Navy's Bureau
of Medicine and Surgery.
—NASA News. Release No. 64-268, October 23, 1964.
MORTAR SHELL CASUALTIES FROM BIEN
HOA AIRBASE TREATED AT U. S. NAVY
STATION HOSPITAL, SAIGON
Viet Nam, 2 Nov 1964 — Fifteen hours after com-
munist Viet Cong mortar shells began falling on U, S.
Military planes and personnel at Bien Hoa Airbase,
Navy doctors, nurses and corpsmen at the U. S. Navy
Station Hospital here were still treating the wounded.
Casualties began arriving by helicopters shortly after
2 A.M. this morning and were rushed to the hospital
which cares for U. S. Military personnel wounded in
combat in the southern part of RVN. The hospital's
fleet of ambulances shuttled wounded from a medical
evacuation Helo landing field most of the morning.
The field is a six-minute ride from the hospital emer-
gency and operating rooms. A few minutes after re-
ceiving word of the action about 2 A. M., the hos-
pital's entire staff was alerted and went into action.
As the wounded arrived, the extent of their injuries
was determined and each casualty received immediate
treatment accordingly. By 2 P. M., 14 U. S, Army and
2 USAF enlisted men had been treated for wounds
received in the Bien Hoa attack. By that time, only
two were reported on the serious list and one was
described as critical. The U. S. Navy Station Hospital,
Saigon, which is the only U. S. Navy medical facility in
the world involved in the treatment of war-wounded
direct from the field of action, is especially set up to
handle mass combat casualties. It has a staff of 9
Navy Medical Officers, 2 Medical Service Corps offi-
cers, 8 Navy Nurse Corps Officers, and 73 Navy
Hospital Corpsmen. The hospital is a facility of the
U. S. Navy Headquarters Support Activity, Saigon,
Commanded by Captain Archie C. Kuntze, U. S. Navy.
U. S. NAVY MEDICAL NEWS LETTER
NEW INFORMATION ON AFIP POST GRADUATE SHORT COURSES
FOR SECOND HALF OF FISCAL YEAR 1965
In the U. S. Navy Medical News Letter issue of 23
October 1964, Vol. 44. No. 8, page 25, there were
listed the postgraduate short courses for FY 1965
scheduled at U. S. Army facilities and at the Armed
Forces Institute of Pathology. The following two
courses are added to that list:
The inclusive dates for the Annual Armed Forces In-
stitute of Pathology Lectures — 1965, should be 29
Mar-2 Apr 1965 MC, instead of the dates listed in the
above reference (15-19 Feb 1965 MC).— Editor
11-15 Jan 65
12-16 Apr 65
IMPORTANT CORRECTION NOTICE FOR
U. S. NAVY MEDICAL NEWS LETTER OF
23 OCT 1964, VOLUME 44,
NO. 8, PAGE 24
Reference is made to paragraph 4d (2) (a) of
BUMED INSTRUCTION 6230.1 1C; which is cor-
rected to read as follows:
"The tablet size for pyrimethamine, used in pediatric
practice for malaria suppression, is incorrectly stated in
BUMED INSTRUCTION 6230. 11C. The correct size
is 25 mg., the only size available commercially. For
greater convenience in use, the dosage has been recom-
puted on an age basis instead of a body weight basis.
As given in ALNAV No. 44, the correct dosage is now
12.5 mg. (one-half tablet) once weekly for children ages
1 through 14 years, and 6.3 mg. (one-fourth tablet)
once weekly for infants under one year of age."
Holders of the above issue of the Medical News
Letter are requested to make these important changes
in pen and ink. — Editor
WHO AIDS TUBERCULOSIS CAMPAIGN IN PERU
The Government of Peru; with the assistance of the
Pan American Sanitary Bureau (WHO Regional Office
for the Americas) and UNICEF, is to conduct a cam-
paign against tuberculosis among the 100,000 inhabi-
tants of its three southernmost provinces, Tacna,
Tarata, and Mariscal Nieto. In Tacna, which borders
on Chile and has an area of 4182 square miles, the
tuberculosis case rate for 1961 was 760 per 100,000
population as against 425 for the entire country.
The aim is to take radiographs and carry out tuber-
culin tests of at least 80% of the population of the
three provinces between 1964 and 1966. Mass BCG
vaccination programmes will protect those in good
health and tuberculosis sufferers will receive drug treat-
ment. WHO is to provide technical personnel, including
a tuberculosis specialist, a statistician, and a public
health nurse, and it will also give fellowships to Peruvian
health workers to study tuberculosis control methods
abroad. UNICEF will provide $58,000 worth of equip-
ment and supplies, including a mobile x-ray unit. The
Government of Peru will meet the local costs of the
programme, which are estimated to be $46,000 a year.
—WHO Chronicle 18(9): 357, September 1964.
HOME NURSING FILM
A motion picture series of 10 half-hour films, en-
titled "The Home Nursing Story," makes it easier for
persons to learn how to safeguard family health, to
know what to do when illness strikes and how to care
for the sick and injured if disaster disrupts family life.
The series was made for the American Red Cross by
the Army Signal Corps, with funds provided by the
Office of Civil Defense.
A companion workbook contains tips on teacher
preparation and how to present the films. It also lists
possible followup activities. Information about loan
or purchase of the film series may be obtained through
local American Red Cross chapters. — Public Health
Reports 78(12): 1060, December 1963.
U. S. NAVY MEDICAL NEWS LETTER
MEDICAL ABSTRAC TS
Mobile Emergency Cart for Intensive Care Ward-
USNH, Newport. Rhode Island
FROM THE NOTE BOOK
Recent Changes in Medical Training Programs
3 Navy Doctors Win Awards at Armed Forces
Dr. Kazmierski First Woman Optometry Officer in
The Value of "Intensive Care" Training
American Board Certifications
A Look at Our U. S. Naval Hospitals — Bremerton,
DENTAL SECTIO N
Evaluation of Direct and Indirect Pulp Capping
The Oral Tissues' Response to Ultrasonic Instru-
DENTAL SECTION (Cont'd)
Thermal Conductivity of Restorative Materials and
Objectives of Dental Education
Personnel and Professional Notes
Medical Aspects of Space Flight
Change of Command Ceremony at U. S. Naval
Aviation Medical Center
Presentation of Navy Commendation Medal
Navy Nurse Given Medal for Perfect School Record
Thermometers (Bagging to Reduce Cross Infection)
Navy Nurse Corps' Conference
The Value of a Navy Career
Dr. Walton Jones Named Acting Head of NASA
Mortar Shell Casualties from Bien Hoa Airbase
DEPARTMENT OF THE NAVY
U. S. NAVAL MEDICAL SCHOOL
NATIONAL NAVAL MEDICAL CENTER
BETHESDA. MARYLAND 20014
POSTAGE AND FEES PAID
PERMIT NO. 104S
U. S. NAVY MEDICAL NEWS LETTER